Journal of neurotrauma最新文献

{"title":"Rosalind Franklin Society Proudly Announces the 2024 Award Recipient for <i>Journal of Neurotrauma</i>.","authors":"Yelena G Bodien","doi":"10.1089/neu.2024.0014.rfs2024","DOIUrl":"https://doi.org/10.1089/neu.2024.0014.rfs2024","url":null,"abstract":"","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":"42 7-8","pages":"637"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain Imaging Features in Patients with Gunshot Wounds to the Head.","authors":"Ali Mansour, Elena Badillo-Goicoechea, Ronald Alvarado-Dyer, Olga Pasternak, Huy Tram N Nguyen, Farima Fakhri, Elaine Lo, Joseph Wilson, Mark DeGuzman, Molly Lawrence, John Nugent, Harsh Desai, William Roth, Jordan Fuhrman, Peleg Horowitz, Paramita Das, Andrii Sirko, Tracey Fan, Elizabeth Carroll, Susan Rowell, Christos Lazaridis, Maryellen Giger, Fernando D Goldenberg","doi":"10.1089/neu.2024.0464","DOIUrl":"10.1089/neu.2024.0464","url":null,"abstract":"&lt;p&gt;&lt;p&gt;To introduce the UChicago PBI Imaging score, a novel characterization of imaging features using head computed tomography (HCT) in patients with gunshot wounds to the head (GSWH) resulting in penetrating brain injury (PBI) and to quantify the association with mortality. We retrospectively collected and analyzed data from 230 patients with GSWH admitted to our Level 1 trauma center between May 1, 2018, and October 31, 2023. HCT images obtained on hospital arrival were evaluated for predefined imaging features by two blinded readers and arbitrated, when needed, by a third. The average contribution of each radiological feature to mortality at hospital discharge was assessed using a SuperLearner ensemble model trained on ∼77% of the cohort. Each feature's contribution was scaled to ensure the additive final score per patient ranged between 0 and 100. The HCT features predicting in-hospital mortality, ranked from highest to lowest importance, were transhemispheric projectile below the level of the third ventricle (18 [16.8, 19.9]), presence of blood in the lateral ventricles (ventricles casted) (18[16.8, 19.6]), brainstem involvement (14 [12.7, 15.1]), transhemispheric projectile above the level of the third ventricle (11 [9.7, 11.6]), presence of any amount of blood in the ambient cistern (9[8.2, 10]), presence of any amount of blood in the lateral ventricles (9 [7.9, 9.8]), cerebellar involvement (9 [7.9, 9.5]), any evidence of ventricular effacement (4 [3.4, 4.6]), midline shift (MLS) &gt;0 mm (4 [3.4, 4.4]), perforating injury (3 [2.4, 3.2]), and presence of an intracerebral hematoma (ICH) &gt;20 mm in the largest diameter (2 [1.4, 1.9]). The UChicago PBI Imaging score showed a strong performance, achieving an area under the curve (AUC) of 0.86 (95% CI: [0.77, 0.96]) on a test set of 56 patients who were not included in model training. This indicates better prediction accuracy compared to both the Rotterdam score (AUC 0.8, 95% CI: [0.68, 0.96]) and the Marshall score (AUC 0.66, 95% CI: [0.52, 0.81]). Our model performed particularly well for patients with a Glasgow Coma Scale (GCS) score between 5 and 9. In this range, our model's performance (AUC 0.86) remained stable, while the Rotterdam and Marshall Scores showed notably lower predictive accuracy, with AUCs of 0.61 and 0.52, respectively. A dedicated evaluation of GSWH HCT reveals an association between disease burden, as quantified by unique features not native to blunt TBI imaging models, and mortality. Specifically, transhemispheric injury below the level of the third ventricle along with blood-casting bilateral ventricles and brainstem involvement was highly associated with mortality. The model is optimized for intermediate GCS scores where greater prognostic uncertainty exists. This study parallels efforts to refine TBI classification, underscoring the necessity for precise imaging-based classification in PBI to identify imaging biomarkers and ultimately enhance prognostication and targeted","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"689-699"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI).","authors":"Jai Carmichael, Jennie Ponsford, Kate Rachel Gould, Jeggan Tiego, Miriam K Forbes, Roman Kotov, Alex Fornito, Gershon Spitz","doi":"10.1089/neu.2024.0006","DOIUrl":"10.1089/neu.2024.0006","url":null,"abstract":"<p><p>Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the <i>Diagnostic and Statistical Manual of Mental Disorders (DSM)</i> and <i>International Classification of Diseases (ICD)</i>. The <i>Hierarchical Taxonomy of Psychopathology (HiTOP)</i> offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. Using a top-down, exploratory latent variable approach (bass-ackwards modeling), we subsequently constructed a hierarchical model of psychopathological dimensions tailored to TBI. The results showed that, relative to norms, participants with moderate-severe TBI experienced greater problems in the established HiTOP internalizing and detachment spectra, but fewer problems with thought disorder and antagonism. Fourteen of the 56 scales demonstrated psychometric problems, which often appeared reflective of the TBI experience and associated disability. The Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI) model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: <i>Detachment</i>, <i>Dysregulated Negative Emotionality</i>, <i>Somatic Symptoms</i>, <i>Compensatory and Phobic Reactions</i>, <i>Self-Harm and Psychoticism</i>, <i>Rigid Constraint</i>, and <i>Harmful Substance Use</i>. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming the limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"714-730"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the Neuropsychiatric Sequelae of Traumatic Brain Injury with Hierarchical Taxonomy of Psychopathology.","authors":"Lucia M Li, David L Brody","doi":"10.1089/neu.2025.0066","DOIUrl":"10.1089/neu.2025.0066","url":null,"abstract":"","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"638-639"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence for Altered White Matter Organization After Mild Traumatic Brain Injury: A Scoping Review on the Use of Diffusion Magnetic Resonance Imaging and Blood-Based Biomarkers to Investigate Acute Pathology and Relationship to Persistent Post-Concussion Symptoms.","authors":"Melissa G Papini, André N Avila, Melinda Fitzgerald, Sarah C Hellewell","doi":"10.1089/neu.2024.0039","DOIUrl":"10.1089/neu.2024.0039","url":null,"abstract":"<p><p>Mild traumatic brain injury (mTBI) is the most common form of traumatic brain injury. Post-concussive symptoms typically resolve after a few weeks although up to 20% of people experience these symptoms for >3 months, termed persistent post-concussive symptoms (PPCS). Subtle white matter (WM) microstructural damage is thought to underlie neurological and cognitive deficits experienced post-mTBI. Evidence suggests that diffusion magnetic resonance imaging (dMRI) and blood-based biomarkers could be used as surrogate markers of WM organization. We conducted a scoping review according to PRISMA-ScR guidelines, aiming to collate evidence for the use of dMRI and/or blood-based biomarkers of WM organization, in mTBI and PPCS, and document relationships between WM biomarkers and symptoms. We focused specifically on biomarkers of axonal or myelin integrity post-mTBI. Biomarkers excluded from this review therefore included the following: astroglial, perivascular, endothelial, and inflammatory markers. A literature search performed across four databases, EMBASE, Scopus, Google Scholar, and ProQuest, identified 100 records: 68 analyzed dMRI, 28 assessed blood-based biomarkers, and 4 used both. Blood biomarker studies commonly assessed axonal cytoskeleton proteins (i.e., tau); dMRI studies assessed measures of WM organization (i.e., fractional anisotropy). Significant biomarker alterations were frequently associated with heightened symptom burden and prolonged recovery time post-injury. These data suggest that dMRI and blood-based biomarkers may be useful proxies of WM organization, although few studies assessed these complementary measures in parallel, and the relationship between modalities remains unclear. Further studies are warranted to assess the benefit of a combined biomarker approach in evaluating alterations to WM organization after mTBI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"640-667"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<b>Vasomotion and Cerebral Blood Flow in</b> Patients With <b>Traumatic Brain Injury and Subarachnoid Hemorrhage: Cerebrovascular Autoregulation Versus Autonomic Control</b>.","authors":"Timothy Howells, Anders Hånell, Teodor Svedung Wettervik, Per Enblad","doi":"10.1089/neu.2024.0426","DOIUrl":"10.1089/neu.2024.0426","url":null,"abstract":"<p><p>This study compared the roles of extraparenchymal autonomic nervous system (ANS) control of cerebral blood flow (CBF) versus intraparenchymal cerebrovascular autoregulation in 487 patients with aneurysmal subarachnoid hemorrhage (SAH) and 413 patients with traumatic brain injury (TBI). Vasomotion intensity of extraparenchymal and intraparenchymal vessels were quantified as the amplitude of oscillations of arterial blood pressure (ABP) and intracranial pressure (ICP) in the very low frequency range of 0.02-0.07 Hz, or periods of 55-15 sec, computed with a bandpass filter. A version of the pressure reactivity index (PRx-55-15) was computed as the correlation of the filtered waveforms, ABP-55-15 and ICP-55-15. Since ABP-55-15 is measured in the radial artery, any influence of cerebral factors must be mediated by the ANS. ICP-55-15 is measured in the brain and is influenced by intraparenchymal chemical and metabolic factors in addition to the ANS. Patient outcome was assessed using the Extended Glasgow Outcome Score (GOSe). Ten-day mean cerebral perfusion pressure (CPP) was negatively correlated with GOSe in the TBI cohort (<i>R</i> = -0.13, <i>p</i> = 0.01) but positively correlated with GOSe in the SAH cohort, (<i>R</i> = 0.32, <i>p</i> < 0.00001), indicating a much greater dependence on ANS support in the form of elevated CPP in SAH. The optimal CPP range for TBI was 60-70 mmHg, but for SAH it was 110-120 mmHg. The percentage of monitoring time with PRx-55-15 < 0.8, indicating very pressure-active cerebral vessels that resist ANS influence via systemic ABP, is positively correlated with GOSe in the TBI cohort (<i>R</i> = 0.14, <i>p</i> = 0.003), but negatively correlated with GOSe in the SAH cohort (<i>R</i> = -0.10, <i>p</i> = 0.004). The TBI cohort optimal PRx-55-15 for patient outcome was -1.0, while the SAH optimum was 0.3. For the TBI cohort, the correlation of ABP-55-15 amplitude with 10-day mean ICP-55-15 amplitude was 0.29. For the SAH cohort the correlation was 0.51, which is stronger (<i>p</i> = 0.0001). The TBI cohort had a median GOSe of 5 (interquartile range [IQR] 3-7), while SAH had a median of 3 (IQR 3-5), which is worse (<i>p</i> < 0.00001). The higher optimal CPP in patients with SAH, more passive optimal pressure reactivity, and greater dependence of cerebral on systemic vasomotion indicate that they require more active support by the ANS and systemic circulation for CBF than patients with TBI. CBF in patients with TBI is more reliant on cerebrovascular autoregulation based on metabolic demand. This appears to be deficient following SAH, making the heightened ANS support necessary. Although this support is beneficial, it does not fully compensate for the loss of cerebrovascular autoregulation, as reflected in the problems in the SAH cohort with delayed cerebral ischemia and poor outcome.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"700-713"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Neural Stem Cell Therapy for Traumatic Brain Injury-A Systematic Review of Pre-Clinical Studies.","authors":"Sarah L Schantz, Kylee J Duberstein, Erin E Kaiser, Franklin D West","doi":"10.1089/neu.2024.0544","DOIUrl":"10.1089/neu.2024.0544","url":null,"abstract":"<p><p>Human neural stem cells (hNSCs) possess significant therapeutic potential for the treatment of traumatic brain injury (TBI), a leading cause of global death and disability. Recent pre-clinical studies have shown that hNSCs reduce tissue damage and promote functional recovery through neuroprotective and regenerative signaling and cell replacement. Yet the overall efficacy of hNSCs for TBI indications remains unclear. Therefore, this systematic review aims to evaluate hNSC interventions compared with controls in pre-clinical TBI models. Through this process, variations in hNSC administration protocols were consolidated, and key knowledge gaps were identified. Meta-analysis was applied to primary outcomes of lesion volume, Morris Water Maze (MWM) performance, modified Neurological Severity Scores (mNSS), and the rotarod task. Narrative review of secondary outcomes included hNSC survival and differentiation, endogenous neuron survival, axonal injury, and inflammation. Overall, hNSC intervention reduced lesion volume, enhanced MWM performance, and led to trending decreases in acute and chronic neurological deficits at acute and chronic time points. These results suggest hNSCs demonstrate clear efficacy in pre-clinical TBI models. However, further studies are needed to address key questions regarding optimal hNSC administration (e.g., dosing, treatment window) and underlying mechanisms of action prior to progressing to human clinical trials.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"668-688"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Design and Implementation of a Dual Compartment Imaging Chamber to Assess Effects of Hypertonic Saline on Periaxonal Swelling and Axonal Spheroid Formation Following Cervical Contusive Spinal Cord Injury in Real Time.","authors":"Francisco Cortez-Thomas, Spencer O Ames, Sarayu Alli, Emma Jones, David P Stirling","doi":"10.1089/neu.2024.0454","DOIUrl":"https://doi.org/10.1089/neu.2024.0454","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Contusive and compressive spinal cord injury (SCI) induces pathological changes to spinal cord white matter (WM) including periaxonal swelling and resultant disruption of the axomyelinic interface, axonal swelling/spheroid formation, and secondary axonal transection. To further our knowledge of the role of vascular edema in these pathological changes to WM, we designed, and three-dimensional (3D) printed a dual-compartment imaging chamber separated by a semipermeable membrane to mimic and manipulate interstitial and vascular fluid compartments in real time. We hypothesized that hypertonic saline (HTS) applied to the \"vascular\" chamber would osmotically shift fluid out of the periaxonal space and preserve myelinated fibers after SCI. Adult male and female 6- to 8-week-old &lt;i&gt;Thy1&lt;/i&gt;&lt;sup&gt;YFP+&lt;/sup&gt; transgenic mice underwent a C5, mild contusive SCI (30 kilodyne, IH Impactor) &lt;i&gt;in vivo,&lt;/i&gt; and their spinal cords were harvested for &lt;i&gt;ex vivo&lt;/i&gt; imaging. Utilizing longitudinal two-photon excitation microscopy (2PE), we imaged both myelin (Nile red) and axons (YFP+) simultaneously up to 4 h after SCI. C5 contusive SCI conditions induced significant increases in periaxonal swelling and axonal spheroid formation within the dorsal column fibers over time. In contrast, perfusion of 3% and 5% HTS in the \"vascular\" compartment beginning 30 min after SCI was highly protective and significantly reduced periaxonal swelling and axonal spheroid formation from 1 h 30 min to the last hour recorded (4 h post-SCI) compared to normal saline (NS) controls. At 2 post-SCI, treatment with 3% and 5% HTS significantly (Kruskal-Wallis ANOVA on Ranks, &lt;i&gt;H&lt;/i&gt;(3) = 3, &lt;i&gt;p&lt;/i&gt; = 0.05, &lt;i&gt;n&lt;/i&gt; = 5-6/group) reduced periaxonal swelling compared to NS (median, 25th percentile; 11.00, 4.00 &lt;i&gt;versus&lt;/i&gt; 9.00, 7.00 &lt;i&gt;versus&lt;/i&gt; 48.00, 29.50, respectively; Dunn's method, both &lt;i&gt;p&lt;/i&gt; &lt; 0.05). By 4 h post-SCI, treatment with 3% and 5% HTS significantly (&lt;i&gt;H&lt;/i&gt;(3) = 15.74, &lt;i&gt;p&lt;/i&gt; = 0.001, &lt;i&gt;n&lt;/i&gt; = 5-6/group) decreased axonal spheroids compared to NS (5.00, 3.00 &lt;i&gt;versus&lt;/i&gt; 4.00, 3.00 &lt;i&gt;versus&lt;/i&gt; 95.00, 38.75, &lt;i&gt;p&lt;/i&gt; = 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, respectively). In contrast, 7.5% HTS had no beneficial effect. Collectively, these data provide insight into the dynamic interplay between interstitial fluid exchange within the periaxonal space and pathological changes in myelinated fibers following SCI. Delayed &lt;i&gt;in vivo&lt;/i&gt; administration of 3% HTS significantly increased axonal survival and reduced periaxonal swellings 24 h post SCI compared to NS control, validating the translatability of our dual compartment imaging chamber (mean, standard deviation; 58.09, 3.34 &lt;i&gt;versus&lt;/i&gt; 32.08, 5.98, &lt;i&gt;p =&lt;/i&gt; 0.003; 595.19, 326.10 &lt;i&gt;versus&lt;/i&gt; 1525.25, 259.82, &lt;i&gt;p&lt;/i&gt; = 0.018, respectively). Our findings suggest that low-dose hypertonic solutions may have a protective effect in part by mitigating periaxonal swelling and thereby potentially reducing the occurrence of axona","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse Axonal and Vascular Pathology in the Gyrencephalic Brain after High-Energy Blunt Injury: Clinicopathological Correlations Involving the Brainstem.","authors":"Athanasios S Alexandris, Karin Rafaels, Michael Horsmon, Samantha Wozniak, Joseph Belamarich, Payton Flores, Constantine E Frangakis, Jiwon Ryu, Diego Iacono, Daniel Perl, Vassilis E Koliatsos","doi":"10.1089/neu.2024.0306","DOIUrl":"10.1089/neu.2024.0306","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) after high-energy, behind helmet blunt trauma (BHBT) is an important but poorly understood clinical entity often associated with apnea and death in humans. In this study, we use a swine model of high-energy BHBT to characterize key neuropathologies and their association with acute respiratory decompensation. Animals with either stable or critical vital signs were euthanized within 4 h after injury for neuropathological assessment, with emphasis on axonal and vascular pathologies in the brainstem. The majority of cases were characterized by fractures of the cranium at or about the impact site, extensive subarachnoid hemorrhages, coup and contrecoup contusions, and primarily diffuse axonal and vascular lesions throughout the cerebrum, particularly in the brainstem. Absence of spontaneous respiration that was encountered frequently was associated with both severity of impact and the severity of brainstem axonal and vascular lesions. A focused regional examination of brainstem pathology indicated a link between adverse outcomes and diffuse axonal lesions within the medial medulla or vascular lesions within the anteroventral brainstem, a pattern suggesting that injury to brainstem respiratory centers may play a role in apnea following BHBT. In addition, while the overall burden of diffuse axonal and vascular pathologies correlated with each other, we found minimal overlap in their regional distribution. Our findings indicate that high-energy, blunt-force impact TBI causes diffuse lesions in axons and blood vessels associated with poor outcomes. They also suggest that axons and vessels may have distinct responses to tissue deformation and that commonly used markers of vascular pathology, for example, in diagnostic radiology, cannot be used as direct surrogates of diffuse axonal injury. In concert, our study underscores the role of regional axonal and vascular injuries in the brainstem in acute respiratory decompensation after high-rate blunt TBI, even in the presence of head protection; it also emphasizes the importance of detailed clinicopathological work in complex brains in the field of TBI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"417-436"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Post-Traumatic Epilepsy on Mental Health and Multidimensional Outcome and Quality of Life: An NIDILRR TBIMS Study.","authors":"Nabil Awan, Justin Weppner, Raj G Kumar, Shannon B Juengst, Kristen Dams-O'Connor, Mitch Sevigny, Ross D Zafonte, William C Walker, Jerzy P Szaflarski, Amy K Wagner","doi":"10.1089/neu.2024.0117","DOIUrl":"10.1089/neu.2024.0117","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Traumatic brain injury (TBI) and subsequent post-traumatic epilepsy (PTE) often impair daily activities and mental health (MH), which contribute to long-term TBI-related disability. PTE also affects driving capacity, which impacts functional independence, community participation, and satisfaction with life (SWL). However, studies evaluating the collective impact of PTE on multidimensional outcomes are lacking. Thus, we generated a model to investigate how PTE after moderate-to-severe (ms)TBI affects TBI-associated impairments, limits activities and participation, and influences SWL. Of 5108 participants with msTBI enrolled into the National Institute for Disability, Independent Living, and Rehabilitation Research TBI Model Systems between 2010 and 2018 and with seizure-event data available at year-1 post-TBI, 1214 had complete outcome data and 1003 had complete covariate data used for analysis. We constructed a conceptual framework illustrating hypothesized interrelationships between year-1 PTE, driving status, functional independence measure (FIM), depression and anxiety, as well as year-2 participation, and SWL. We performed univariate and multivariable linear and logistic regressions. A covariate-adjusted structural equation model (SEM), using the lavaan package (R), assessed the conceptual framework's suitability in establishing PTE links with outcomes 1-2 years post-injury. Multiple parameters were evaluated to assess SEM fit. Year-1 PTE was correlated with year-1 FIM motor (standardized coefficient, β&lt;sub&gt;std&lt;/sub&gt; = -0.112, &lt;i&gt;p&lt;/i&gt; = 0.007) and showed a trend level association with year-1 FIM cognition (β&lt;sub&gt;std&lt;/sub&gt; = -0.070, &lt;i&gt;p&lt;/i&gt; = 0.079). Individuals with year-1 PTE were less likely to drive independently at year 1 (β&lt;sub&gt;std&lt;/sub&gt; = -0.148, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). In addition, FIM motor (β&lt;sub&gt;std&lt;/sub&gt; = 0.323, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), FIM cognition (β&lt;sub&gt;std&lt;/sub&gt; = 0.181, &lt;i&gt;p&lt;/i&gt; = 0.012), and anxiety (β&lt;sub&gt;std&lt;/sub&gt; = -0.135, &lt;i&gt;p&lt;/i&gt; = 0.024) influenced driving status. FIM cognition was associated with year-1 depression (β&lt;sub&gt;std&lt;/sub&gt; = 0.386, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and year-1 anxiety (β&lt;sub&gt;std&lt;/sub&gt; = 0.396, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), whereas year-1 FIM motor (β&lt;sub&gt;std&lt;/sub&gt; = 0.186, &lt;i&gt;p&lt;/i&gt; = 0.003), depression (β&lt;sub&gt;std&lt;/sub&gt; = -0.322, &lt;i&gt;p&lt;/i&gt; = 0.011), and driving status (β&lt;sub&gt;std&lt;/sub&gt; = 0.233, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) directly affected year-2 objective life participation metrics. Moreover, year-1 depression (β&lt;sub&gt;std&lt;/sub&gt; = -0.382, &lt;i&gt;p&lt;/i&gt; = 0.001) and year-2 participation (β&lt;sub&gt;std&lt;/sub&gt; = 0.160, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) had direct effects on year-2 SWL. SWL was influenced indirectly by year-1 variables, including functional impairment, anxiety, and driving status-factors that impacted year-2 participation directly or indirectly, and consequently year-2 SWL, forming a complex relationship with year-1 PTE. A sensitivity analysis SEM showed that the number of MH disorders was associated with participation and SWL (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), an","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"399-416"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}